Brain Reading Technology

Reading minds is not as far fetched as it seemed to be in the past. With much research and technology, verbalizing a person’s thought process appears possible.

Introduction

Brain reading is a process in which there is indulgence in neural responses evoked by the brain through stimulus followed by a detection through fMRI to decode the original stimulus. This was proposed by neuroscientist Marcel Just and his colleagues at Carnegie Mellon University. Through artificial intelligence technology, they analyzed complex brain activities and deciphered the patterns in equivalence to the brain functioning. This involves construing the way one thinks of a number or an object, reads a sentence, or expresses an emotion in parallel with addition of their futuristic approach to a particular thought. Suicidal tendencies are very common due to emotional disturbances and the tendency to conceal this even from loved ones. This process enables one to detect if the person is having a thought of suicide by just analyzing his brain’s response to words like happiness or death. This could even prove as a life saving method.

Sir Elon Musk’s Recent Discovery

After much research and human trials, the owner of the Tesla, Elon Musk, recently came up with the discovery of a surgically implantable device called Neurolink chip that can read the user’s brain using brain wave technology and decoding speech waves. This will promote easy communication between human brain and machine which might prove to be a boon to cure many medical problems.

Fig: Neurolink

The chipset will be installed in the skull with it’s surgical placement through the artificial intelligence technology. It is said to have thickness in parallels to the brain neurons and thinness as the hair strand with the facility of multiple devices to be fitted in different sections of the brain. Partial anaesthesia might be given during the process.As for how it’s working, is taken into account it’ll be analogous to our brain working action.Our brain sends information to different parts of the body through the neuronal network called neurotransmitters, generating electric fields. The actions are then recorded with placement of electrodes translating them into algorithms in accordance with the understanding for the machines. In this manner Neuralink will be able to read our minds and find a way for communication between humans and machines.

Fig: Elon Musk’s surgical robot for implantation of Neurolink

Neurolink needs quick and precise insertions into the brain cortex, therefore keeping safety measures in mind a surgical robot is designed for this purpose. This robot will ensure perfect insertion of the module into the brain which isn’t visible to the naked eye. The robot is designed in such a manner which will not only ensure quickness,preciseness and perfection but also insertion without contact with any arteries or veins thus avoiding any complications or side effects. This will then be completed by covering the exposed part of the skull with the chipset module.

At the start of it’s usage, it’ll be beneficial for the paraplegic and epileptic patients with operational and interactive sessions with the machines. In others with loss of optic nerve control, a help to bring back their eyesight could be made possible. In paralytic patients restoration of memory, speech and motility could be ensured. If this project proceeds a new technology could come into being where along with human to machine interaction may be possible similarly human to human interaction could also be possible without actually communicating. 

Conclusion

It might prove as a blessing or curse will be perceived in the mere future. On one hand where it can be proved as a boon for improving health conditions similarly on the other hand it might be harmful as one’s private thoughts might be captured and misused by the companies acquainted with this technology,thus violating their neurorights. The technology is almost on the verge of becoming a reality,hence one needs to now figure out how to keep up with the ethical morals and standards. Soon this will no longer be imagining design fiction.

Pratiksha Baliga, Youth Medical Journal 2022

References

[1]Fields, R. D. (2020, March 10). Mind reading and mind control technologies are coming. Scientific American Blog Network. https://blogs.scientificamerican.com/observations/mind-reading-and-mind-control-technologies-are-coming/.

[2]John, C. (2020, July 24). Neuralink explained: How we will talk to machines using our brain. TheQuint. https://www.thequint.com/explainers/what-is-neuralink-and-how-does-it-work-explained.

[3]Ethrington, D. (2020). Elon Musk Neurolink. Google image result for https://techcrunch.com/wp-content/uploads/2020/08/the-prototype-robot-being-tested-in-the-lab.jpg. Retrieved April 23, 2022, from https://images.app.goo.gl/fggzFMLz59ZZzxDr6

[4]Archyde, A. (2020, August 29). Neuralink presents its first functional device to read nervous system activity. Archyde. Retrieved April 23, 2022, from https://www.archyde.com/neuralink-presents-its-first-functional-device-to-read-nervous-system-activity/

Advertisement

Omicron Virus: Another COVID Variant of Concern

An overview of the current variant of SARS-CoV-2 virus leading to the continuity of the current pandemic situation.

Origin of Pandemic & Succeeding Omicron

With the emergence of the current pandemic of respiratory illness all over the world due to transmission of an infectious disease,COVID-19. It was first reported on 1st December,2019 and is said to have originated from an animal and gradually caused illness in humans due to continued mutation. It is spread through droplets and particles released into the air when an infected person breathes, talks or sneezes. Larger droplets fall to the ground within a few seconds, but tiny infectious particles can linger in the air and accumulate in indoor places with overcrowding and poor ventilation. The patient initially may be asymptomatic in mild conditions but if the infection proceeds further they may develop symptoms of cough,fever with chills, dyspnea,sore throat,ageusia and anosmia with additional associated ones being diarrhoea, nausea, vomiting,malaise, headache.

The Omicron Virus,B.1.1.529 variant was first reported to WHO from South Africa on 24 November 2021. The first known confirmed B.1.1.529 infection was from a specimen collected on 9 November 2021. The exact transmissibility of the variant is not yet known,compared to other variants. It multiples approximately 70 times faster than delta variant in the bronchi,but it’s severity is considered to be 91percent less as compared to the previous strains with hospitalization reduced to 51percent. It can lead to reinfection.

Astonishing Anatomy

During the discovery of the Alpha variant back  in November 2020, scientists had very little knowledge about it’s mutations and it’s association with the behavioural pattern. Now with the subsequent years passing by and discovering new knowledge scientists have researched into its detail. They have been able to link some of the Omicron variant’s mutations to the mechanisms which has caused it’s spread, quickly and effectively.

Omicron virus hosts twice as many mutations as other variants of concern. There are 13 mutations on its spike protein that are rarely seen among other variants. This has led to a difference in the anatomy of the omicron variant from the rest of the variants. This includes four ways leading to this change,three of which have helped the virus evade our immune systems causing it to be more infectious, while the fourth may have led it to produce more mild diseases. Other variants include attack of antibodies by binding to the spike protein of the virus,whereas omicron has mutations to amino acids in two regions of spike,the receptor binding domains and N terminal binding domains. Thus the neutralizing effect is reduced. 

In the preceding variants three amino acids on Receptor binding domains were mutated, altering each of them just enough to prevent some antibodies from recognizing it. But Omicron recides 15 receptor binding domain mutations, mainly on the prime antibody binding sites in a disguised form in order to prevent many more antibodies.

The spike protein has two subunits to separate as the infection of virus to the cell takes place. In older variants they were attached and frequently split too early.

The spikes S1 and S2 are loosely attached which allow them to split apart quickly so the spike can bury itself in a human cell when the virus encounters one,this may also lead to the split of viruses prematurely before nearing the cell.

The older virus variants relied on a surface protein of human cells called TMPRSS2 to help it break through the cell membrane,whereas omicron does not rely on it,instead uses only ACE2 to get inside.

Last but not the least,the fourth change which involves vulnerability to a part of our bodily defenses,the innate immune system. It is said that this vulnerability may prevent it from spreading into the deeper organs.

Clinical features, Diagnosis & Treatment

Omicron Virus possesses clinical features like loss of taste and smell similar to the delta variant with comparatively reduced severity.A characteristic feature of omicron variant is night sweats. A study performed by the Center for Disease Control found that the most commonly reported symptoms were cough, fatigue, and congestion or runny nose making it difficult to distinguish from a less damaging variant or other viruses. Less common symptoms were found consisting of sore throat, headache, aches, pains, diarrhoea,skin rash discolouration of fingers or toes and red or irritated eyes. Sometimes they may show serious symptoms like dyspnea, loss of speech or mobility, confusion,chest pain. If anybody possesses any of these symptoms then they should urgently head forward for COVID testing.

Less common symptoms were found consisting of sore throat, headache, aches, pains, diarrhoea,skin rash discolouration of fingers or toes and red or irritated eyes. Sometimes they may show serious symptoms like dyspnea, loss of speech or mobility, confusion,chest pain. If anybody possesses any of these symptoms then they should urgently head forward for COVID testing.

It is of the saying that S-gene target failure is suggestive of Omicron differentiating it from Delta. The identification  can also be performed by sequencing and genotyping. Rapid antigen testing is also a diagnostic technique but has very little evidence.To ensure prevention,WHO recommended that people should continue to maintain ventilation, avoid overcrowding and close contact, wear well-fitting masks, clean hands frequently, and get vaccinated.

Remdesivir and Tocilizumab may be used in its treatment protocol for patients with moderate to severe illness. Remede Sivir may inhibit the virus multiplication. Tocilizumab is a monoclonal antibody which puts a stop to a possible cytokine storm.

Conclusion

It is of assumption that the current wave is because of omicron according to epidemiological and scientific evidence. Hopefully once RT-PCR tests which can indicate omicron’s presence are made available, distinguishing treatment would become easier. With the ongoing pandemic situation cases are turning milder compared to the second wave,thus many of whom are home quarantined with over the counter medication. Symptomatic management is of utmost importance among the medical fraternity. There is yet much to be researched and discovered for enhancing the current situation. Hopefully with new discoveries and vaccination dosage the situation will be brought to control in the future.

Pratiksha Baliga, Youth Medical Journal 2022

References

[1]MMWR, C. D. C. (2021, December 16). SARS-COV-2 B.1.1.529 (omicron) variant – united states, December 1–8, 2021. Centers for Disease Control and Prevention. Retrieved February 21, 2022, from https://www.cdc.gov/mmwr/volumes/70/wr/mm7050e1.htm

[2]Scudellari, M. (2022, February 11). Omicron’s surprising anatomy explains why it is wildly contagious. Scientific American. Retrieved February 21, 2022, from https://www.scientificamerican.com/article/omicrons-surprising-anatomy-explains-why-it-is-wildly-contagious/

Vacuum Induced Uterine Tamponades (VIUTs) for Postpartum Hemorrhages

A stroke of brilliance: a faster and simpler non-surgical intervention to tamponade uterine bleeding in postpartum complications.

Background

When a new life comes into this world, the delivery involves uterine contraction. It pushes out the placenta, which exerts pressure onto the bleeding vessels attached to the placenta. If the uterine contraction is restricted or obstructed for any reason, or there is residual attachment of placenta, these blood vessels bleed freely. The result is excessive placental bleeding (compared to normal conditions), causing a postpartum hemorrhage. Postpartum hemorrhages are one of the most significant causes of mortality due to childbirth worldwide, creating a demand for effective solutions as incidence rates rise. In most cases, postpartum hemorrhage is caused by atony – the failure of the uterus to contract after delivery. Atony is regularly prevented through use of oxytocic drugs that induce uterine contraction. When prevention fails, the uterus must be mechanically stimulated to contract. The most common solution used in developing countries is the balloon system which exerts outward hydrostatic pressure on the uterus.

Intrauterine balloon systems with applications of an intrauterine vacuum are a promising new method. It aims to reduce uterine size for the control of a postpartum hemorrhage with no additional intervention required thereafter. With advancing technology the vacuum induced uterine tamponade (VIUT) has come into play. It was created through a device inserted transvaginally into the uterine cavity. An occlusion balloon built into the device shaft was inflated to the level of the external cervical os (the junction between the cervix and the vagina) to create a uterine seal.

Internal mechanics of VIUTS

The process consists of applying low level intrauterine vacuum to facilitate physiologic forces of uterine contractions to constrict myometrial blood vessels and achieve homeostasis. 

The tamponade itself is made of medical grade silicon, of which the distal end (placed in the uterus) is an elliptical loop, containing 20 vacuum pores on its inner surface. The proximal end of the tamponade has a vacuum connector.

Prior to the beginning of the process of placing the device, a manual sweep of the uterine cavity is performed. After this, a Bakri balloon is inserted into the uterus, given that either a postpartum hemorrhage has occurred (and treatment consists of oxytocin followed by prostaglandins), or when uterine bleeding has continued despite removal of placenta or retained placental tissue.

The procedure¹ further includes inflation of the balloon with 50-100 ml of physiologic saline solution. The catheter is then connected to a non sterile tube, which is in turn connected to a vacuum device, at which point an intrauterine vacuum is applied with 60-70kPa. The tube positioning and uterine cavity condition must be monitored through ultrasonography to detect an unwanted accumulation of blood. If no bleeding is visible then the patient is stable and the balloon should be deflated completely and removed.

In very rare cases, this process requires additional antibiotics or analgesia administration.

The time taken for uterine collapse and hemorrhagic control is relatively short. In the prospective study² carried out, the initial collapse of the uterus took a median of one to two minutes from the time of vacuum connection. Bleeding came into control within 5 minutes for 82 percent of women. The median overall duration of the vacuum treatment was 144 minutes (median being 85-295 minutes), which includes the required 60 minutes of vacuum treatment time and 30 minutes of observation without any vacuum connected, but with the device still in place.

Fig 2: Vacuum induced uterine tamponade in vitro observed in ultrasonography

Conclusion

The above study, as well as an FDA review³ that followed, deemed the device to be safe. Some possible adverse effects were found, such as endometriosis, laceration, and vaginal infection. However, these were resolved in further trials without any serious clinical consequences.

Although the method has yielded confidence from its success rates, VIUTs must undergo periodic evaluations. Further investigation should be undertaken to determine whether the success rates found so far were solely due to vacuum induced uterine tamponade methods or proper management of postpartum hemorrhage patients. The majority of clinicians (according to this poll²) reported that the vacuum induced hemorrhagic control device was easy to use and recommended it for future patients.

Pratiksha Baliga, Youth Medical Journal 2022

References

1. Haslinger, C., Weber, K. and Zimmermann, R., 2022.  Vacuum-Induced Tamponade for Treatment of Postpartum Hemorrhage. [online] National Center for Biotechnology Information. Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8366764/>

2. D’Alton ME, Rood KM, Smid MC, Simhan HN, Skupski DW, Subramaniam A, Gibson KS, Rosen T, Clark SM, Dudley D, Iqbal SN, Paglia MJ, Duzyj CM, Chien EK, Gibbins KJ, Wine KD, Bentum NAA, Kominiarek MA, Tuuli MG, Goffman D, M., 2020. National Library of Medicine: National Centre for Biotechnology Information. 2022. Intrauterine Vacuum-Induced Hemorrhage-Control Device for Rapid Treatment of Postpartum Hemorrhage. [online] Available at:

<https://pubmed.ncbi.nlm.nih.gov/32909970/>

3. D’Alton, M., Rood, K., Simhan, H. and Goffman, D., 2022. Profile of the Jada® System: the vacuum-induced hemorrhage control device for treating abnormal postpartum uterine bleeding and postpartum hemorrhage. [online] Taylor & Francis. Available at: <https://www.tandfonline.com/doi/full/10.1080/17434440.2021.1962288>

Transient Hypofrontality

Introduction

When one enters a flow state, they experience a condition in which the focused thinking part of the brain turns static for a portion of time. This reduces the dominance of the focused part, allowing the other parts to function greater with more efficiency. Dr. Arne Dietrich, a professor at the American University of Beirut, came up with the term transient hypofrontality, which means that activities like meditation and exercise indulge the brain in a redistribution process known as downregulation. She states that the number of receptors for a neurotransmitter is decreased, typically in response to an increase in neurotransmitter release. She further states that this indulgence in the flow state makes one’s brain focus in the direction of making complex decisions, which brings the prefrontal cortex into a static state, thereafter bringing an alteration in the consciousness.

The Science of Flow

Flow is a mental state which makes one engrossed in a particular activity by diverting their attention towards it. It helps to discover one’s peak abilities in challenging circumstances that engage their fullest capacities. This push to perform at the limits of our ability makes one feel alive and engaged, bringing about enjoyment, pleasure, and happiness. It brings about a pattern of neurochemical changes heightening our senses and increasing our cognitive and motor skills. This initiates one to fight against pressures and thus reach conclusions of those problems. It not only creates pathways for cooling down the mental states but also engages in learning activities. Therefore, it plays an important role in attention focusing, energizing, learning superpowers, creativity, and enjoyment.

Working

The Dorsolateral Prefrontal Cortex is the part of the brain which permits one to self-regulate and is responsible for one’s executive functioning. It helps one to think rationally and plan logically, acting as the parental advisor of the brain. It plays a very important role in decision making and avoiding any wrong long-term mistakes while questioning oneself about their behaviour. However, its con is that it hinders the process of quick reactions and instead focuses on overanalyzing, causes self-criticism, and can lead one to overthink and worry. This overthinking leads to a loss of the pure sense of flow. Here the transient hypofrontality can come into play, inducing the flow state of the brain. It focuses on deactivating the front of one’s brain, so the level of higher functioning in the brain decreases, allowing the brain to flow.

The Dorsolateral Prefrontal Cortex needs to be shut off during this process, diverting the brain to bring other parts into play which one should use without censorship or micromanagement. The result will be quick reactions and uninterrupted productivity. The decrease in the dominance of the Prefrontal Cortex increases the dominance of the other parts, igniting the expanded levels of human potential. One example is losing control in keeping track of time, leading to the past, present, and future melding into one. The brain waves will change, converting from regular beta waves to alpha-theta waves. In this process, the gamma waves occur, binding ideas from all areas of the brain, connecting memories and experiences, and bringing new stimuli into creative action, thus a flow in the making to control the person’s emotional status. The transient hypofrontality has its main focus towards engaging in activities like meditation and exercise. During this process, there is extensive neural activation that runs motor patterns, assimilates the sensory inputs, and coordinates autonomic regulation, resulting in a concomitant transient decrease of neural activity in brain structures, specifically the prefrontal cortex, which are not pertinent to performing the activity. An exercise-induced state of frontal hypofunction can provide a crystal clear account of the influence of the activity on one’s emotion and cognition.

Conclusion

A theoretical basis of transient hypofrontality is yet to be established through constant reviews, supportive evidence, and relevant data. Although different behavioral methods are used to achieve different states, it is observed that all altered states share a common neural mechanism of a transient decrease in prefrontal cortex activity. Furthermore, it is hypothesized that different induction methods target specific prefrontal circuits, removing their computation from the conscious experience. This results in the uniqueness of the altered states. In the mere future, the hypothesis may stimulate research and will encourage researchers from different backgrounds to address testable hypotheses derived from it.

Pratiksha Baliga, Youth Medical Journal 2022

References

1]F.Hays, K. (2017). The Transient Hypofrontality Edge. Psychology Today. https://www.psychologytoday.com/intl/blog/the-edge-peak-performance-psychology/201703/the-transient-hypofrontality-edge.

2]Dietrich, A. (2006, November 1). Transient hypofrontality as a mechanism for the psychological effects of exercise. Psychiatry Research. https://www.sciencedirect.com/science/article/abs/pii/S0165178106000199.

Sarpa Sutta

An insight into a nagging dosh often called so by Indians in which a stripe of blisters occur anywhere on the patient’s body, wrapping around it like a snake.

Introduction

Sarpasutta often referred to as in local language and known by names like Shingles or Herpes Zoster is a viral disease often characterized by a painful rash with blisters on the skin in a localized area. It occurs in a strip-like pattern either on the left or the right side of the body or face. It is caused by a virus called Varicella zoster virus which is the same virus causing chicken pox thus there is a close relationship between the lifecycle of both of these diseases. It is considered as a continuation of chickenpox infection in which even after this infection is resolved, the virus lives in one’s body for years in the dorsal root ganglia and later reactions to Herpes Zoster.

Fig: Shingles

Clinical features

The patients with this virus latent in their body show reactivation signs with the rash formation on the trunk along the dermatome, most commonly being T5 and T6. The most frequently involved cranial nerve dermatome is the ophthalmic division of the trigeminal nerve.

Depending on the skin tone, the rash can appear dark pink, dark brown, or purplish. The rash is painful, itchy or tingly which develops into a cluster of vesicles. These vesicles continue to form over three to five days and progressively dry and crust over. Healing takes place within two to four weeks but might result in permanent pigmentation changes and scarring on the skin. They can appear anywhere on the body having dermatomes in relation. In some, it occurs in and around the eyes referred to as ophthalmic herpes zoster. A blistering rash may appear on your eyelids, forehead, and sometimes on the tip or side of your nose. A throbbing sensation may take place around the eyes accompanied by redness, swelling and blurred vision. Although the rash may disappear, there is persistent pain due to nerve damage. A second location common for its appearance is the posterior region of one’s body. They may vary from developing on one side of the waistline to stripes of blisters on one side of one’s back or lower back region. A third commonly noticed region is one’s buttocks. It’s restricted only to either of the buttocks. The initial symptoms include tinging, itching or pain followed by a red rash or blister formation. This pain may give rise to insomnia in May of the patients.

Treatment

The treatment of herpes zoster mainly should focus on areas of treatment of acute viral infections, the acute pain associated and prevention of any complications.The medications include antiviral agents which have been shown to reduce the duration of herpes zoster as well as its severity of pain. But the criteria are only applicable to those who receive these medications within 72hours of onset. The main drug under this is Acyclovir prototype antiviral drug is a DNA polymerase inhibitor that is given orally but intravenously in immunocompromised patients who are unable to take medications orally. Corticosteroids including Prednisone used in conjunction with acyclovir have been shown to reduce the pain associated with herpes zoster. The reason is decreasing the degree of neuritis caused by active infection and with reduced residual damage to affected nerves.Analgesics are given to reduce the mild to excruciating pain. If severity increases addition of narcotic medication is given.Lotions containing calamine may be used on open lesions to reduce pain and pruritus. Once the lesions have crusted over, capsaicin cream may be applied. Topically administered lidocaine and nerve blocks may also help in reducing pain.

Conclusion

In most of the cases Herpes Zoster is self limiting and suffices with analgesics. It can affect any age group. The requirement of herpes zoster increases with advancing age.More studies are required to confirm the gender specificity, seasonal variations, and regional distribution of herpes zoster.Despite several therapeutic modalities for herpes zoster and its complications, the treatment remains a challenge.

Pratiksha Baliga, Youth Medical Journal 2022

References

[1]Clinic, C. (2020). Shingles (herpes zoster): Symptoms, treatment &amp; prevention. Cleveland Clinic. Retrieved November 29, 2021, from https://my.clevelandclinic.org/health/diseases/11036-shingles.

[2]Camila K Janniger, M. D. (2021, July 22). Herpes zoster. Practice Essentials, Background, Pathophysiology. Retrieved November 29, 2021, from https://emedicine.medscape.com/article/1132465-overview.

[3]Practo Health Wiki. (n.d.). Shingles/herpes zoster: Symptoms, complications, and treatment. Practo. Retrieved November 29, 2021, from https://www.practo.com/health-wiki/shinglesherpes-zoster-symptoms-complications-and-treatment/72/article.

Stoneman’s Syndrome

A particular type of syndrome where damaged soft tissues regrow as bone. Thus sufferers are imprisoned by their skeleton.

Introduction

One of the rarest genetic diseases and a connective tissue disorder with autosomal dominant inheritance. It is characterized by abnormal ectopic calcification of tendons, ligaments, skeletal muscles, excluding the smooth muscle—the deformity results in restricted joint movements at the corresponding sites and respiratory failure and pulmonary infections.The most common cause of Stoneman syndrome is a mutation of the gene ACVR1. It leads to defects in the body’s repair mechanism. It is an autosomal dominant disorder. Thus, a child of an affected heterozygous parent and an unaffected one has a 50% probability of being affected. Two affected individuals can produce unaffected children. Two unaffected individuals can produce an affected offspring due to the mutation of the gene. The protein that causes ossification is deactivated in standard cases after a fetus’s bone formation, but in Stoneman’s syndrome, the reverse happens. This process leads to the formation of lymphocytes containing Bone Morphogenetic Protein4(BMP4), which contributes to the development of the skeleton in the normal embryo. The ACVR1 gene encodes the bone morphogenic protein (BMP) receptor mutated in this syndrome. This genetic result concludes in an overgrowth of bone and cartilage and the fusion of the joints.

DNA sequencing electropherograms of a typical FOP patient being compared to the other two patients. The unsure base “N” indicates site heterozygous for the mutation and wild-type gene.

New bone formation takes place, replacing the degenerated tissues. This further leads to the formation of a secondary skeleton, causing restricted mobility of the person’s limbs. The only difference between this bone and the original one is the wrong location.

Clinical Presentation

Usually congenital, children are born with malformations of the big toes, a missing joint, or any kind of lump in the minor joints. The first flare-up which usually leads to this deformity occurs in the age group of below 10years. The growth starts mainly in the upper portion progressing downwards. The ossification of fibrous tissues takes place, which may be sudden or due to traumatic onset. It begins specifically in the dorsal, axial, cranial, and proximal regions of the body. Later the disease progresses in the ventral, appendicular, caudal and distal regions. This bone growth occurring during the flare-up phase results in reduced mobility of affected joints. It also results in knee or hip mobilization causing the patient’s inability to walk. This condition also includes the formation of additional bones. In children, it’s often noticed in the neck, later the shoulders, arms, chest, and concluding at the feet. If this extra bone formation occurs at the ribcage, it will result in restricted respiratory movements due to limited lung expansion and ribcage.

As this disorder has characteristic findings, it can be easily diagnosed with plain radiographs. It presents with signs of the shortened great toe with a malformed distal first metatarsal and a missing or abnormal first phalanx with or without interphalangeal joint.It is clinically measured by elevated alkaline phosphatase levels and bone-specific alkaline phosphatase. 

AP and lateral radiographs of the neck reveal heterotopic ossification (blue arrow) in the posterior aspect of soft tissues of the neck. The cervical vertebral bodies and the posterior elements are normal in this case. The patient had restriction of neck movements.

Posteroanterior chest radiograph reveals heterotopic ossification (blue arrows) in soft tissues of chest wall and abdomen.

Treatment

Being one of the rarest diseases, there’s no specific cure to date. Some research includes steroids as the treatment but has not yet been confirmed. If the bone is surgically extracted may result in explosive growth of new bones. Anesthesia in surgery may encounter difficulties with changes in the heart’s electrical conduction system, pulmonary diseases, or intubation. Activities including any soft tissue injury or soft tissues should be avoided, leading to this deformity formation.

Conclusion

Fibrodysplasia ossificans progressiva or Stoneman’s syndrome is a rare and disabling disorder; if misdiagnosed, it can lead to unnecessary surgical intervention and high-risk results of early disability. Thus early treatment and measures are needed to prevent further complications. Awareness of this rare disease should be done to reduce the risks of this rare condition.

Pratiksha Baliga, Youth Medical Journal 2022

Reference

[1]Shah, Z. A., Rausch, S., Arif, U., &amp; El Yafawi, B. (2019, December 1). Fibrodysplasia Ossificans Progressiva (Stone Man Syndrome): A case report. Journal of Medical Case Reports. Retrieved October 30, 2021, from https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-019-2297-z.

[2]Dhivakar​1, M., Prakash1, A., Garg1, A., Agarwal1, A., I, A.-S., S, R., A, A. H., GK, D., NM, H., M, O. C., DL, G., EM, S., FS, K., J, H., A, S., A, B., M, L. M., RJ, P., RE, G., … K, T. (2020, June 29). Fibrodysplasia Ossificans Progressiva (stoneman syndrome) – a rare skeletal dysplasia. Indian Journal of Musculoskeletal Radiology (IJMSR). Retrieved October 30, 2021, from https://mss-ijmsr.com/fibrodysplasia-ossificans-progressiva-stoneman-syndrome-a-rare-skeletal-dysplasia/.

[3]Kekatos, M. (2019, March 20). Hope for people with disease that turns tissue to bone as three drugs enter clinical trial. Daily Mail Online. Retrieved November 12, 2021, from https://www.dailymail.co.uk/health/article-6831009/amp/Hope-people-disease-turns-tissue-BONE-three-drugs-enter-clinical-trial.html.

[4]Grahm Russell, R. (2009). Novel mutations in ACVR1 result in atypical … – researchgate. Research Gate. Retrieved November 12, 2021, from https://www.researchgate.net/publication/24242503_Novel_Mutations_in_ACVR1_Result_in_Atypical_Features_in_Two_Fibrodysplasia_Ossificans_Progressiva_Patients.

The Real Gallants

By Praktisha Baliga

Published 10:10 EST, Wed Novemember 3rd, 2021

A poem depicting the life of the doctors who are the true fighters of our nation whose sacrifice and determination often goes unnoticed.

It takes a full life to realise what is True,

To earn the title Doctor is a pride for all but a dream of only a Few. Take it or leave it, it’s up to You.

Take it or leave it, it’s up to You.

It’s a lifelong journey which has to be fulfilled by You.

They acquire a lot of knowledge throughout their medical Career,

But when a patient with an unknown disease arrives it’s their biggest Barrier.

They work like soldiers at the borders to save lives at the risk of their own Demise,

Seeing the patient fully cured is their biggest Prize.

They relate every aspect of their life with their medical life,

Whenever they see a Crescent moonlight Night,

They are reminded of P falciparum gametocyte.

They possess virtues which can’t be measured by a Test.

They have special qualities which make them stand apart from the Rest.

They have the patience to calm a disturbed mind.

Being objective and also very Kind.

Applaud to the doctors who sincerely do Care.

They are like those precious stones who are found very Rare.

Let’s stand up and clap for our heroes Today,

Salute and wish them a very 

Happy Doctor’s Day

Pratiksha Baliga, Youth Medical Journal 2021

Bioelectronic Medicine

By Pratiksha Baliga

Published 6:39 PM EST, Sat July 17, 2021

Introduction

Bioelectronic Medicine consists of implantable devices that will use electricity to regulate biological processes, treat diseases, and restore lost functionality. These devices would work in a manner in which they will induce, block, and sense electrical activity by taking into account the Peripheral Nervous System at the centre to progress with advances mainly concerned with chronic diseases and their control.  It will be attached to individual peripheral nerves, thereby deciphering and modulating neural signaling patterns, achieving a therapeutic effect targeting the signal function of a specific organ. These miniaturized device components will create flexible and biocompatible materials. The biggest problem with drugs is that, although they cure diseased cells, they also result in adverse reactions. Bioelectronic Medicine, as compared to drugs, will be designed with more efficiency and will comprise of expandable components for computation and power, thus reducing the side-effects and costs. It will focus on precision to reach specific targeted locations.

Ongoing Research

The research is ongoing to discover a particular methodology of harnessing the body’s peripheral wiring, which might help in the treatment of acute and chronic diseases. Dysfunctional neural circuits give rise to dysfunctional organs. The aim of bioelectronic medicine is to counteract this condition by restoring electronic impulses with adjustments of neuron firings, thereby changing the neurotransmitter concentrations traveling through those circuits.  An alternative way is emerging including neuromodulation, biostimulation, or electroceuticals to deteriorate the expense of costly chemical and biological drugs.

The human body is electric. Peripheral nerves connect all organs to the central nervous system These nerves are packaged in bundles and carry about 100,000 nerve fibers. A peripheral nerve is also the longest nerve in the body, linking the brain to the organs and controlling breathing and heart rate. It goes everywhere to gain access to a bunch of different targets. Some of the researchers believe that this is the greatest promise for bioelectronic medicine, which, by manipulating the vagus nerve, can control inflammation and the immune response and drive most chronic disease. Also, acetylcholine, the principal neurotransmitter that stems from the vagus nerve, inhibits the production of cytokines such as the tumor necrosis factor, an inflammatory molecule involved in rheumatoid arthritis.

These implants are very small in size. Researchers and engineers are into a mindset of not blindly zapping a large bundle of nerves. Instead, they are collaborating on the basic physiology and high-tech tools needed to zero in on the specific subset of fibers known to innervate the organ of interest. Further changes are thought to personalize this device in such a manner as changing the pulse, width, amplitude, or frequency of stimulation. Unlike as with many pharmacologic agents, a plan is executed to be selective with therapeutic effects along with its reduced side effects as well.

Such a device would not only develop connections with the nerves, but also with the rest of the body to decipher and develop the best response in real-time by stimulating or blocking nerve signals. For example, diabetes might involve the pancreas to make more insulin when it’s needed. In the gastrointestinal system, an electrode might sense the motility rate of the gut and then determine the optimal frequency of pulses to speed it up or slow it down. The ultimate goal is to restore a healthy pattern of electrical pulses.

Future Aspects

In the upcoming future, the vision of revolutionizing the system of medicines will come to fruition. Bioelectronic medicines hold the promise in achieving the therapeutic intervention by modulating the signalling patterns of the nerves’ impulses. These medicines include devices which are implanted anywhere in the viscera and record the neural activity. However, the upcoming research is thought to focus on three principal areas. Firstly, making of an instinctive nerve atlas is pivotal as this focuses on mapping the innervation of visceral organs such as the lungs, heart, liver, pancreas, kidney, bladder, gastrointestinal tract, lymphoid organs, and reproductive organs. The objective is achieving resolution at the level of nerve fibers and action potentials. Secondly, neural interfacing technology helps in mapping neural signals, which includes ultrasonic and tomography techniques for recording and modulation. Thirdly, when the particular signaling pattern is characterized, the focus drifts towards confirmation of rule, which implies characterizing which neural circuit exerts impact over which disease in the representative animal model. After that, an experimental phase is sought after, which includes developing the correlation of neural signals and biomarkers patterns and also investigating the effect of blocking and stimulating neural activity during established disease. Thus, altogether this revolution in the medical fraternity might bring a change in the society introducing a new class of precision medicine to patients.

Pratiksha Baliga, Youth Medical Journal 2021

Reference

1]Peeples, L. (2019, December 3). Core Concept: The rise of bioelectric medicine sparks interest among researchers, patients, and industry. PNAS. https://www.pnas.org/content/116/49/24379.

2]S Chaudhary, D. A. P. A. T. E. L. (2020, August 26). BIOELECTRONIC MEDICINES: INNOVATION IN DISEASE TREATMENT: INTERNATIONAL JOURNAL OF PHARMACEUTICAL SCIENCES AND RESEARCH. IJPSR. https://ijpsr.com/bft-article/bioelectronic-medicines-innovation-in-disease-treatment/?view=fulltext.

3]Ramkissoon, A. C. M., Datta-Chaudhuri, A. T., Authors: Eugenio Redolfi Riva and Silvestro Micera, D. K. J. T., Mehta, A. N., Peng, A. S., Authors: Amparo Güemes and Pantelis Georgiou, D. K. J. T., Addorisio, A. M. E., Bonaz, A. B., Leitzke, A. M., &amp; Bettinger, A. C. J. (2021, May 25). Bioelectronic Medicine. https://bioelecmed.biomedcentral.com/.

Artificial Blood-A Mystery Soon to be a Reality

By Pratiksha Baliga

Published 3:03 PM EST, Tues June 1, 2021

Introduction

Blood is a transport liquid pumped by the heart to all parts of the body and vice versa to repeat the process. It is also a tissue with a collection of similar specialized cells that serve particular functions. It is composed of red blood cells for transportation of oxygen and carrying back of carbon dioxide to exhale, white blood cells to fight infections, platelets to heal by clotting of blood in injuries, and plasma for circulation of platelets and blood cells in the body.

Artificial blood is a blood substitute used to mimic and fulfill some vital functions of the biological blood like the transport of oxygen and carbon dioxide. It is useful during life-sustaining conditions with serious blood loss. They cannot carry out secondary functions like fighting infections. Nowadays with the growing need for blood and reduced availability of donors, the creation of artificial blood is a need for millions. 

Prerequisites

Human blood has a composition of products that need to be added to make artificial blood. First and most importantly it should ensure compatibility thus in this case the types of blood should not vary and be similar for all. It should also fulfill the purpose of the patient’s safety, to be able to process and remove the disease-causing agents like microorganisms, bacteria, and viruses, being pathogen-free. Secondly, the important aspect is regarding the transportation of oxygen and carbon dioxide. This feature is considered to be fulfilled by recent research. Third, it must be shelf-stable. Human blood can only be stored for a relatively short period. According to the Red Cross, storage of blood cells is done in the refrigerator at 6°C for 42 days, while platelets can be stored at room temperature in agitators only for 5days. So unlike donated blood, artificial blood should be able to be stored for at least a year or more. 

Perfluorocarbons

Perfluorocarbons are a group of human-made chemicals composed of carbon and fluorine. They are thought to be used to design artificial blood and dissolve about 50 times more oxygen than blood plasma. They are inexpensive and do not require any biological materials. In making it useful for artificial blood ongoing research is in talking terms in which certain hurdles have to be overcome. Firstly, correction in its solubility in water has to be brought about, which can be achieved by its combination with emulsifiers that can suspend its tiny particles in the blood. Secondly, the quantity of Perfluorocarbons has to be large as they carry much less oxygen than hemoglobin-based products. Thus improved emulsions will be developed in the subsequent time, the process of which has begun. 

Haemoglobin Based Products

Hemoglobin carries oxygen from the lungs to the other body tissues. Artificial blood made according to this principle has an advantage due to its natural function. Unlike in Perfluorocarbons, the oxygen covalently bonds to hemoglobin. It has another advantage of eliminating blood typing as they aren’t contained in a membrane and are different from the whole blood. Along with having the pros, hemoglobin-based also has some cons. Firstly, stability is an issue.

Secondly, its raw material cannot be used as it would lead to breaking down into small toxic products inside the body. Therefore artificial blood hemoglobin-based should be made by resolving these issues. The stability of it can be brought about by chemically cross-linking or using recombinant DNA technology to produce modified proteins.

The cross-linking has specific chemical cross-links which prevent dissociation to dimers or monomers. Therefore these hemoglobins attain the properties of solubility and stability. Thus it is expected that these modified ones should have a greater ability to carry oxygen than our red blood cells. The research is going on and its availability is expected to be within some years.

Process in Making

Perfluorocarbons involve polymerization reactions for the making of artificial blood. Hemoglobin-based products are mostly preferred which can be used by isolation or synthetic production with the use of amino acids. It also uses specific types of bacteria and materials needed to incubate it like warm water, glucose alcohol, urea, acetic acid, and liquid ammonia. Later the process involves molecular modification followed by reconstitution in an artificial blood formula. A strain of E.coli bacteria is taken and in three days the harvesting of protein is done along with the destruction of the bacteria. 

Then starts with the fermentation process where bacterial culture is transferred to the test tube containing all the required nutrients for growth. This step results in bacterial multiplication and transferring to a seed tank which later is transferred to a fermentation tank. This leads to the production of hemoglobin after which the tank is emptied and the isolation process begins. Here the hemoglobin is isolated with the centrifugal separator and purified by fractional distillation. Lastly from here, it is transferred for final processing. It’s mixed with water and electrolytes for the production of usable artificial blood which is later pasteurized and packaged.

Conclusion

The various types of artificial blood are restricted to certain limitations. Researchers and scientists are also coming up with the idea of using hematopoietic stem cells for the production of artificial blood. This is said to have similar morphology with a similar amount of hemoglobin as the natural red blood cells. The Food and Drug Administration is examining the safety of this blood along with its cost-effectiveness. It may also serve as a blood donor to all common blood types. Along with all this currently, many companies are working on the production of safe and effective artificial blood by clearing the various limitations. In the future, it is anticipated that new materials to carry oxygen in the body will be found. Additionally, long-lasting products will be developed, along with the products that perform other functions of the blood effectively. Hopefully, investigations carried out will be beneficial in the upcoming times.

Pratiksha Baliga, Youth Medical Journal 2021

References

(1)Patrick Davis, C. (2020, July 17). What Is Artificial Blood and Why Is it Used? MedicineNet. https://www.medicinenet.com/what_is_artificial_blood_and_why_is_it_used/article.htm.

(2)-, -. (2019, October 29). Artificial Blood: Unsolvable Biological Puzzle Or Soon-To-Be Reality? The Medical Futurist. https://medicalfuturist.com/artificial-blood-unsolvable-biological-puzzle-or-soon-to-be-reality/.

(3)Sarkar, S. (2008, July). Artificial blood. Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2738310/.

Smart Inhalers

By Pratiksha Baliga

Published 1:57 PM EST, Sun May 9, 2021

Introduction

Inhalers are medical devices used to treat chronic obstructive pulmonary disease such as asthma by delivering bronchodilator medication to the airway directly, making use of a fast and sharp inspiratory force, without passing through the blood. The medicine within inhalers uses lactose molecules. Chronic Obstructive Pulmonary Disease affects over 200 million people around the world whereas asthma affects another 300 million. The chronic respiratory disease makes up a little over 8% of the world’s chronic disease burden. In order to mitigate the clinical severity of these conditions, the patients have to adhere to a strict medication schedule, with the dosage and timing being adjusted to achieve control of their symptoms.

With modern times coming into play, inhalers are powered by different forms of technology giving rise to a new generation of devices named Smart Inhalers. They are present with extra digital features of connection with mobile applications and help doctors and patients to manage asthmatic conditions in a better and improved way. 

Working and Features

Monitoring of medication schedules and dosage reminders is its main feature. A sensor on the inhaler communicates with the mobile application via Bluetooth to keep a  track of the inhaler using data in the app. The app records the date, time, and even the location of each dosage intake, and then using this information schedules the user’s next dose reminder. Some of these inhalers use a built-in sensor that is integrated into the body of the inhaler itself, while others, for example, can use propeller sensors which are external sensors that can be attached to various kinds of inhalers. Along with these features these inhalers also have high pollen and pollution alerts or the ability to sense if the user forgets to take their inhaler with them when they leave home. They can also indicate when the patient is overusing their preventive medicine pointing towards poorly controlled asthma.

Nowadays a smart cap called CapMedic for smart inhalers is used by people with asthma, chronic obstructive pulmonary disease, and other respiratory disorders. It is available only by prescription. It has to be placed on top of the inhaler and it houses sensors that guide users and collect data for remote patient monitoring. It connects via Bluetooth providing direct communication with patients for better effectiveness in management. The caps are reusable and rechargeable emitting visual, audio, and haptic signals letting the users know when an inhaler has been adequately shaken and is fully upright, among other parameters that ensure a full dose of medication. It fits on most of the smart inhalers available and pairs with an app on the phone that can send data to a clinician. It also incorporates a spirometer which measures the air capacity of the lungs.

World’s First Smart Inhaler

The world’s first smart inhaler was recently approved by the FDA, and named Teva’s ProAir Digihaler (albuterol sulfate). It was introduced to the United States market through an sNDA application and was said to join Proteus Digital Health as being a potential game-changer for digital medicines.The ProAir Digihaler is built on the RespiClick inhaler formulation. It has a sensor that tracks when it is used in real-time and syncs this data to a mobile app. The patient has to use an app to scan a QR code at the top of the inhaler, which will sync the inhaler to the app. The ProAir Digihaler can determine how well the patient uses it, as the sensor measures a breath actuation and sees how well a patient inhales giving them a rating.

The ProAir Digihaler is built on the RespiClick inhaler formulation. It has a sensor that tracks when it is used in real-time and syncs this data to a mobile app. The patient has to use an app to scan a QR code at the top of the inhaler, which will sync the inhaler to the app. The ProAir Digihaler can determine how well the patient uses it, as the sensor measures a breath actuation and sees how well a patient inhales giving them a rating.

Patients can view their event data through the ProAir companion app, which provides tips to improve inhaler techniques and offers medication reminders if they choose. They can also transmit the data directly to their doctors to keep a track of their condition, its management and bring about improvement in their treatment plan.

Conclusion

Following the wave of connected devices and smart health technologies coming up in the healthcare sectors, the future of digital health innovation will be brighter than before. Smart inhalers are considered by many the way the future will progress, essentially breathing fresh air into the management scope of chronic respiratory treatments in the years ahead. Its demand is considered to increase at a significant rate with novel opportunities to address more challenges associated with accessibility, quality, effectiveness, efficiency, and cost of healthcare.

Pratiksha Baliga, Youth Medical Journal 2021

References

[1]Berg, J., Arundhati Parmar&nbsp;&nbsp;|&nbsp;&nbsp;2:05 pm, A. 14, Stephanie Baum&nbsp;&nbsp;|&nbsp;&nbsp;7:30 am, A. 20, Elise Reuter&nbsp;&nbsp;|&nbsp;&nbsp;3:14 pm, A. 23, Anuja Vaidya&nbsp;&nbsp;|&nbsp;&nbsp;2:15 pm, A. 23, &amp; Frank Vinluan&nbsp;&nbsp;|&nbsp;&nbsp;11:26 pm, A. 23. (2020, January 23). FDA clears smart inhaler cap from Cognita Labs. MedCity News. https://medcitynews.com/2020/01/fda-clears-smart-inhaler-cap-from-cognita-labs/?rf=1.[2]Thomas, D. L. (2021, January 11). What are Smart Inhalers? News. https://www.news-medical.net/health/What-are-Smart-Inhalers.aspx.

[2]Thomas, D. L. (2021, January 11). What are Smart Inhalers? News. https://www.news-medical.net/health/What-are-Smart-Inhalers.aspx.